AAPD Reference Manual 2022-2023

ORAL HEALTH POLICIES: ECC: CONSEQUENCES & PREVENTIVE STRATEGIES

Policy on Early Childhood Caries ( ECC ) : Consequences and Preventive Strategies

Latest Revision 2021

How to Cite: American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): Consequences and preventive strategies. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2022:90-3.

Purpose Early childhood caries ( ECC ), formerly referred to as nursing bottle caries and baby bottle tooth decay, remains a significant chronic disease of childhood and public health problem. 1 The American Academy of Pediatric Dentistry ( AAPD ) encourages healthcare providers and caregivers to implement preventive practices that can decrease a child’s risks of developing this preventable disease to reduce the burden on the child, the family, and society. Methods This policy was developed in a collaborative effort of the American Academy of Pedodontics and the American Academy of Pediatrics ( AAP ) and adopted in 1978. 2 This document is a revision of the previous version, last revised by the AAPD in 2016. 3 The update used electronic and hand searches of English written articles in the dental and medical literature within the last 14 years, using the search terms infant oral health, infant oral health care, early childhood caries, early childhood caries AND oral microbiome, ECC AND oral microbiome, early childhood caries AND prevention, ECC AND prevention. More than 8000 articles were identified in the search. When information from these articles did not appear sufficient or was inconclusive, policies were based upon expert and consensus opinion by experienced researchers In 1978, the American Academy of Pedodontics and the AAP released a joint statement Nursing Bottle Caries to address a severe form of caries associated with bottle usage. 2 Initial policy recommendations were limited to feeding habits, con- cluding that nursing bottle caries could be avoided if bottle feedings were discontinued soon after the first birthday. An early policy revision added ad libitum breastfeeding as a causative factor. Over the next two decades, however, recog- nizing that ECC was not solely associated with poor feeding practices, AAPD adopted the term ECC to better reflect its multifactorial etiology. These factors include susceptible teeth due to enamel hypoplasia, oral colonization with elevated levels of cariogenic bacteria (especially Mutans streptococci [ MS ]), and the metabolism of sugars by tooth-adherent bacteria to produce acid which, over time, demineralizes tooth structure. 4 and clinicians. Background

ECC is defined as “the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth” 5 in a child under the age of six. The definition of severe early childhood caries (S-ECC) is 1) any sign of smooth-surface caries in a child younger than three years of age, 2) from ages three through five, one or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth, or 3) a decayed, missing, or filled score of greater than or equal to four (age three), greater than or equal to five (age four), or greater than or equal to six (age five). 5 Epidemiologic data from a 2011-2012 national survey clearly indicate that ECC remains highly prevalent in poor and near- poor United States (U.S.) preschool children. 6 For the overall population of preschool children, the prevalence of ECC, as measured by decayed and filled tooth surfaces (dfs), is unchanged from previous surveys, but the filled component (fs) has greatly increased indicating that more treatment is being provided. 6 The consequences of ECC often include a higher risk of new caries lesions in both the primary and permanent dentitions 7,8 , hospitalizations and emergency room visits 9,10 , high treatment costs 11 , loss of school days 12 , diminished ability to learn 13 , and diminished oral health-related quality of life 14 . Traditional microbial risk markers for ECC include acido- genic-aciduric bacterial species, namely MS and Lactobacillus species. 15 Studies using direct culture with arbitrarily primed polymerase chain reaction (AP-PCR) fingerprinting and other traditional techniques have shown that MS maybe transmit ted vertically from parent or caregiver to child and horizontally from other individuals in his immediate environment. 16,17 Newer technologies that sequence DNA and RNA in a rapid and cost-effective manner, known as high-throughput or new- generation sequencing (e.g. polymerase chain reaction, rRNA gene sequencing), reveal the complexity of the oral microbiome and have highlighted other bacterial species (e.g., Scardovia wiggsiae , Veillonella ssp.) and fungi (e.g., Candida albicans ) ABBREVIATIONS AAPD: American Academy Pediatric Dentistry. AAP: American Academy of Pediatrics. CWF: Community water fluoridation. ECC: Early childhood caries. mg: Milligram. MS: Mutans streptococci. U.S.: United States.

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